What to do?

What needs to be done for your infant?
Practical agenda at a glance

Immediately after Birth

Start immediately with gentle range of motion exercises. Have a physiotherapist teach you how to exercise your baby's arm. It's important that you don't get too upset early on because there is a very high chance for spontaneous recovery (70-80%).

After 8-10 Days

If paralysis is still present, call a clinic that specializes in obstetric paralysis. EMG has no indication and no value at this stage.

At 1 month

The baby should be seen at this age by a brachial plexus specialist and also must continue with physiotherapy. There is no need for splint at this stage.

At 3 months

The surgeon will decide upon primary surgical repair if there is absence of recovery of biceps or complete hand paralysis with Horner's syndrome (see algorithm).
At that stage EMG, which has little value to predict recovery, may be useful for the determination of possible avulsion injuries. EMG testing can be less painfull with the use of anaesthetic cream one-hour prior.
Fluoroscopy can also be important, as it will determine if the phrenic nerve is involved. In that case, the diaphragm does not work on the affected side. Respiratory problems may occur in such cases. At that stage CT myelogram may be useful for some difficult diagnosis.
Physiotherapy continues with specifics as prescribed by the surgeon.

Every 3 months

The child is seen by the surgeon to follow recovery and check for medial rotation contracture. Physiotherapy continues.

After 2 years

The upper roots have completed their recovery. Functional movements might be improved with "secondary surgery". Physiotherapy continues.

After 4 years

B one and joint deformities may have occurred. At this age, it is very important to perform a CT scan or MRI of the shoulder joint in order to evaluate the possibility of an appropriate secondary surgery. Bone surgery (osteotomies, joint releases) may be necessary.
Active physiotherapy is slowly replaced by daily physical activities and swimming. Physiotherapy follow-up, however is very important and should continue throughout the child's life.